Clinical Intake
Prepare for your screening
01
Complete Intake
02
Send to Nanjiba
03
Physical Screening
Do you need a professional screening?
Before you visit Nanjiba for a full microscopic scalp analysis, fill out this quick intake form. This allows us to understand your specific concerns, lifestyle factors, and hair history so we can tailor your consultation perfectly.
Why do we need this?
Every scalp is entirely unique. By understanding your lifestyle, medical history, and specific symptoms before you arrive, Nanjiba can use the microscopic screening session to precisely diagnose the root causes of your concerns, rather than spending time asking basic intake questions.